Welcome to today’s webinar! Some things to note: Please send Questions in chat to the 1. Organizer – will have Q&A at the end. Please mute your phones, computers. 2. Today’s webinar will be recorded and 3. posted to iData’s blog. Please send an email to 4. jcosta@idatamedical.com for CEUs All information in this deck is confidential – property of Revint Solutions RESULTS | EXPERIENCE | VALUE Page 1
Sandra Routhier, RHIA, CCS, CDIP AHIMA-Approved ICD-10-CM/PCS Trainer sandy.routhier@cloudmedsolutions.com Sandy is an HIM & Coding professional with more than 30 years of experience with a strong emphasis on inpatient coding and reimbursement, medical record documentation requirements, HIM operations, electronic records, regulatory and accreditation requirements. Sandy worked in acute care hospitals for 25 years in a variety of roles including inpatient coding and CDI specialist, HIM director, revenue cycle director and information systems director. Sandy is currently the SVP of Auditing Services at CloudMed, a Revint Solution. CloudMed provides a unique full- coverage software and auditing solution to assure the accuracy of coding and documentation on inpatient cases. CloudMed, A Revint Solution https://revintsolutions.com/ Revint Solutions is an industry-leading full-service healthcare solutions and consulting services provider that offers revenue integrity and recovery services for hospitals and health systems to ensure accurate and timely reimbursement for their services. Serving over 1,600 healthcare organizations in the United States, Revint helps recover over $475 million of underpaid or unidentified revenue for its clients annually. Revint’s suite of products includes transfer DRG/IME revenue recovery, DRG validation, zero balance underpayment recovery, Medicare reimbursement, complex claims, consulting, and interim management, offering solutions of a full revenue integrity “safety net” for all types of healthcare provider organizations. Revint is backed by New Mountain Capital, a growth-oriented investment firm that currently manages over $20 billion in assets. All information in this deck is confidential – property of Revint Solutions All information in this deck is confidential – property of Revint Solutions Page 2 Page 2
From Accurate Patient Story Documentation to Coded Data Integrity: Auditing for Consistency, Accurate Reimbursement, and more! Wednesday, October 17, 2018 at 12:00 noon All information in this deck is confidential – property of Revint Solutions RESULTS RESULTS | | EXPERIENCE EXPERIENCE | | VALUE VALUE Page 3
From Documentation to Coded Data Medical Record Code Reimbursement Documentation Assignment All information in this deck is confidential – property of Revint Solutions Page 4
From Documentation to Coded Data Hospital Inpatient Reimbursement Medical Records Physicians Billing Claim Coders “Congestive heart failure I13.0 MS-DRG 291 (acute on chronic systolic), I50.23 Heart Failure Hypertension, and N18.4 with MCC Chronic Kidney Disease (stage IV)” Projected DRG Reimbursement: MS-DRG Relative Weight: 1.4761 Hospital’s Blended Rate: X $5,000 $7,380 All information in this deck is confidential – property of Revint Solutions Page 5
From Documentation to Coded Data Accuracy Needed for all the Reasons Coded Data is Used q Vital statistics related to population health q Quality projects such as core measures q Comparative Data – hospital and physician q Severity of Illness (SOI) and Risk of Mortality (ROM) q Hospital acquired conditions (HACs) q Patient Safety Indicators (PSIs) q Readmission rates q Clinical Research q Disease Maintenance q Registries (i.e., tumor, trauma, birth defects) q Physician credentialing and privileging q Payer contract negotiations, market share analysis, transparent pricing q MEDPAR data All information in this deck is confidential – property of Revint Solutions Page 6
From Documentation to Coded Data Hospital Medical Records Paper-based Hybrid Electronic All information in this deck is confidential – property of Revint Solutions Page 7
From Documentation to Coded Data Center for Medicare and Medicaid Services (CMS) � 482.24 Condition of participation: Medical record services q A medical record must be maintained for every individual evaluated or treated in the hospital. q All patient medical record entries must be legible, complete, dated, timed, and authenticated in written or electronic form by the person responsible for providing or evaluating the service provided, consistent with hospital policies and procedures. q The hospital must have a system of coding and indexing medical records. The system must allow for timely retrieval by diagnosis and procedure, in order to support medical care evaluation studies. All information in this deck is confidential – property of Revint Solutions Page 8
From Documentation to Coded Data Center for Medicare and Medicaid Services (CMS) � 482.24 Condition of participation: Medical record services q Evidence of q History and Physical (H&P) q Consultative evaluations q Practitioner’s orders q Discharge summary with outcome of hospitalization, disposition of case, and provisions for follow-up care q Documentation of complications, hospital acquired infections, and unfavorable reactions to drugs and anesthesia q Completion of medical records within 30 days following discharge All information in this deck is confidential – property of Revint Solutions Page 9
From Documentation to Coded Data Accreditation Requirements q The Joint Commission q Record of Care, Treatment, and Services (RC) q https://www.jointcommission.org/ q DNV q Integrates the CMS Conditions of Participation with the ISO 9001 Quality Management Program q http://www.dnvglhealthcare.com/accreditations/hospital-accreditation All information in this deck is confidential – property of Revint Solutions Page 10
From Documentation to Coded Data ICD-10-CM Official Guidelines for Coding and Reporting q General Guideline I.B.14: Code assignment is based on documentation by the patient's provider AHA Coding Clinic q First Quarter 2014 (pages 11-13): Medical record documentation from any physician involved in the care and treatment of the patient, including documentation by consulting physicians, is appropriate for the basis of code assignment. q The issue of whether a resident's documentation needs to be confirmed by the attending physician is best addressed by the hospital's internal policies, medical staff bylaws, and/or any other applicable local/state/ federal regulations. q Code assignment may be based on other physician (i.e., consultants, residents, anesthesiologist, etc.) documentation as long as there is no conflicting information from the attending physician. All information in this deck is confidential – property of Revint Solutions Page 11 q
From Documentation to Coded Data q Unfavorable patient outcomes What’s the impact of poor q Medical errors documentation? q Lack of coordination of care q Lower reimbursement q Low Case Mix Index (CMI) q Denials q Marred public image q Increased costs q Duplicate tests q Administrative costs q Software & Support q Legal q Clinician dissatisfaction All information in this deck is confidential – property of Revint Solutions Page 12
From Documentation to Coded Data Building Safety Nets – Internal Quality Checks q Review documentation for completeness q Validate code assignments are accurate q Utilize internal staff or outside vendor q Perform pre-bill or post-bill Audit Pre- and/or Post-Bill Analyze for Deficiencies Code and Physicians DRG Assignments Medical Records Billing Coders Clinical Documentation CDI Specialists Improvement (CDI) All information in this deck is confidential – property of Revint Solutions Page 13
From Documentation to Coded Data Systems Trending of EMR configuration internal quality Document creation options checks, external System-related issues Optimization audits, and denials Clinical Documentation Improvement Physician and clinician terminology CDI and coding reconciliation Taking action on Clinical Validation what is discovered Coding Coding education and support Process improvement All information in this deck is confidential – property of Revint Solutions Page 14
Questions? Please write your question in the chat! All information in this deck is confidential – property of Revint Solutions Page 15
Sponsor: iData Medical focuses on creating quality clinical documentation documents and overall medical records (accurate patient’s “story”), performs document integrity audits for small and large facilities, and provides back-up services as part of facility contingency and business continuity plans. www.iDataMedical.com All information in this deck is confidential – property of Revint Solutions Page 16
Upcoming: • Our Webinar Series continues in February with another outstanding line-up of speakers and experts in the field of medical documentation integrity “ • A video of this webinar will be available on iData’s blog shortly. • CEU Certificates are available with request by email to: jcosta@idatamedical.com All information in this deck is confidential – property of Revint Solutions Page 17
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